Fluid/function correlation using AI-based quantification versus central subfield thickness in treatment-naïve and pre-treated patients with neovascular AMD in a real-world setting.

Journal: Acta ophthalmologica
Published Date: Sep 18, 2025

Abstract

PURPOSE: To investigate the association between best-corrected visual acuity (BCVA) and quantitative macular fluid volumes, compared to central subfield thickness (CST) in treatment-naïve and previously treated patients with active neovascular age-related macular degeneration (nAMD). METHODS AND ANALYSIS: Baseline data were collected from 290 eyes of 290 participants consecutively enrolled in a prospective, randomized phase III clinical trial. Intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) volumes were quantified and localized using an MDR-certified AI algorithm (Fluid Monitor, RetInSight). Fluid volumes and CST were included in linear regression models for comparison. RESULTS: Significantly greater IRF volumes within each macular region were observed in treatment-naïve patients, whereas larger PED volumes contributed to higher CST values in pretreated patients. In both subgroups, the largest proportion of BCVA variance could be explained by measuring IRF and SRF volumes within the entire 6-mm area (adjusted R2 = 0.140 and 0.225, respectively). In pre-treated eyes, CST explained only half as much BCVA variance as the 6-mm fluid model, and the model's fit was even poorer when compared to the CST model in the treatment-naïve subgroup (adjusted R2 = 0.078 vs. 0.198). CONCLUSION: The examination of IRF and SRF volumes significantly impacts BCVA in nAMD. The weaker association of CST highlights its limitations as a parameter of disease activity. These findings emphasize the necessity of distinct fluid volume quantification as a relevant surrogate for visual function loss or benefit in nAMD, with particular emphasis on treatment duration and fluid in regions beyond the central 1-mm.

Authors

  • Anna Eidenberger
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Gregor S Reiter
    Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. [email protected].
  • Virginia Mares
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Sophie Frank-Publig
    Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Philipp Fuchs
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Magdalena Baratsits
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Markus Gumpinger
    Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Georg Faustmann
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
  • Alexandra Miere
    Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Laboratory of Images, Signals and Intelligent Systems (LISSI), (EA N° 3956), University Paris-Est, Créteil, France. Electronic address: [email protected].
  • Catherine Creuzot-Garcher
    Ophthalmology Department, Dijon University Hospital, Dijon, France.
  • Ulrike Scheschy
    Department of Ophthalmology, Horn Regional Hospital, Horn, Austria.
  • Laurent Kodjikian
    Department of Ophthalmology, Hôpital Universitaire de la Croix-Rousse, Hospices civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France.
  • Vincent Gualino
    Ophthalmology Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France.
  • Benjamin Wolff
    Maison Rouge Eye Center, Strasbourg, France.
  • Stefan Sacu
    Department of Ophthalmology and Optometry, Vienna Clinical Trial Center (VTC), Medical University of Vienna, Vienna, Austria.
  • Ursula Schmidt-Erfurth
    Christian Doppler Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.

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